It may sound odd to graduate therapy during a pandemic. In fact, it may be so rare and strange that there’s no protocol to be found! Maybe it’s because it sounds counterintuitive? Why would someone celebrate completing their therapeutic goals in a time of uncertainty? Isn’t most of the world in a mental health crisis right now?
Although unusual, I have several client preparing to graduate in the middle of COVID-19. I work exclusively with adults, so I also recognize this may be different for professionals who work with youth and families. For some, the pandemic has provided pleasant opportunities as well as the anticipated stressors. Therefore I feel it’s important to explore this topic for clients who are gearing up to graduate.
For the client who now gets to save time and a stressful commute in working from home. The parent who gets to spend more time with their kids. The single mom who received a promotion. The introvert who enjoys working on self-development projects in their living room. The person diagnosed with agoraphobia who just secured a job working remotely. The student who is graduating college with a job offer two months before he walks across a virtual stage.
Even with the heavy, there’s hope! I recognize that this can be privilege. Not everyone has their safety and security needs met to make this possible. Not everyone has the luxury of a two income household or the ability to work from home. So how does this impact individuals who were working on stressors in therapy that have been alleviated in some way thanks to COVID-19? Or for the clients who were in maintenance prior to COVID and remain in maintenance, reflecting ongoing stability through this pandemic?
Can we honor the client who states COVID saved their life? Acknowledge the parent who feels more authentically connected to their community than ever before? It’s a complicated dance of tracking the good, the bad, and the ugly while celebrating clients’ resiliency. For the folks who have experienced minimal negative impact or disruption to their lives, perhaps they entering a space of readiness and comfort with discontinuing therapy.
Recognizing this feeling as both foreign and exciting, let’s take a look as some things to consider when exploring therapy graduation in a pandemic:
1. Stability-Does the client recognize and regularly practice their own coping skills, feeling equipped to handle stressors that could come their way?
2. Resources-Does the client have access to other resources if needed? Personal and professional supports as well as additional tools? Can they return to therapy if needed?
3. Treatment Goals- Has the client completed all their treatment goals to justify a close in services at this time?
4. Medical Necessity- Is there evidence that continuing therapy is a clinical or medical necessity, justifying ongoing work?
5. Burnout- Is the client indicating they need some time to identify new goals or an opportunity to practice their skills without regular therapeutic support? As their therapist, are you also tracking their status in therapy maintenance, where continuing services might lead to client burnout because regular sessions are not feeling as necessary right now?
Graduation Planning
By considering the factors above, you may discover that having a conversation with your client about their readiness and comfort with graduating is an appropriate next step.
A. Identify a Timeline. What kind of time frame does the client need to embrace graduation as a next step? Do they want several sessions to prepare? Is there a set date for the final session where you can both be intentional in processing their experience and identify a symbolic therapy graduation gift if appropriate?
B. Celebrate the Successes. My favorite part of therapy graduation is celebrating client milestones and progress made towards their goals. I start by having them think back to the start of therapy and what was happening for them at that time. Then we walk together through a mental timeline of their successes, challenges, and goals accomplished, emphasizing their strengths.
C. Explore the Signs. The other piece that’s important to explore in a graduation session is the client’s awareness of warning signs that they may need to seek out support from you or another professional. I find it’s important to not only explore the signs, but also the length or duration of the signs being present for the client to practice coping skills on their own versus seeking additional support. This mental exercise results in having a future plan in place that empowers the client and can reduce some of the anxiety they might feel in ending therapy.
D. Re-Engagement or Referrals. How can the client reach you if they need to re-engage in therapy? What referrals can be made available for other providers or specialties that could benefit their desired next steps? What resources can be given preemptively to support them in the transition?
Timing is everything. Graduation from therapy may feel like a far off goal for some of your clients, who are working hard through the challenges of COVID-19. For others, it can feel empowering to explore graduation, having a structured and supportive plan aligned with their long-term goals. After all, therapy is meant to introduce the skills and growth opportunities for clients to eventually try out on their own. A graduation session can serve as an important next step in closure and intentional transition in an otherwise unpredictable and uncertain time.